The Journal of Pain
Volume 11, Issue 1 , Pages 53-61 , January 2010

An Investigation Into the Hypoalgesic Effects of High- and Low-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) on Experimentally-Induced Blunt Pressure Pain in Healthy Human Participants

  • Chih-Chung Chen

      Affiliations

    • Faculty of Health, Leeds Metropolitan University, Civic Quarter, Leeds, United Kingdom
    • Leeds Pallium Research Group, www.leeds.ac.uk/pallium.
    • ,
  • Mark I. Johnson

      Affiliations

    • Faculty of Health, Leeds Metropolitan University, Civic Quarter, Leeds, United Kingdom
    • Leeds Pallium Research Group, www.leeds.ac.uk/pallium.
    • Corresponding Author InformationAddress reprint requests to Professor Mark I Johnson, Faculty of Health, Leeds Metropolitan University, Civic Quarter, Leeds LS1 3HE, United Kingdom.

Received 27 February 2009 ,Revised 1 May 2009 ,Accepted 29 May 2009.

References 

  1. Aarskog R, Johnson MI, Demmink JH, Lofthus A, Iversen V, Lopes-Martins RAB, et al. Is mechanical pain threshold after transcutaneous electrical nerve stimulation (TENS) increased locally and unilaterally? A randomized placebo-controlled trial in healthy subjects. Physiother Res Int. 2007;12:251–263
  2. Ainsworth L, Budelier K, Clinesmith M, Fiedler A, Landstrom R, Leeper BJ, et al. Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation. Pain. 2006;120:182–187
  3. Alves-Guerreiro J, Noble JG, Lowe AS, Walsh DM. The effect of three electrotherapeutic modalities upon peripheral nerve conduction and mechanical pain threshold. Clin Physiol. 2001;21:704–711
  4. American Physical Therapy Association (APTA) Electrotherapeutic Terminology in Physical Therapy. Report by the Electrotherapy Standards Committee of the Section on Clinical Electrophysiology of the American Physical Therapy Association (APTA). Alexandria, VA: APTA; 1990;
  5. Bailey PL, Rhondeau S, Schafer PG, Lu JK, Timmins BS, Foster W, et al. Dose-response pharmacology of intrathecal morphine in human volunteers. Anesthesiology. 1993;79:49–59
  6. Barlas P, Craig JA, Robinson J, Walsh DM, Baxter GD, Allen JM. Managing delayed-onset muscle soreness: Lack of effect of selected oral systemic analgesics. Arch Phys Med Rehabil. 2000;81:966–972
  7. Barlas P, Lundeberg T. Transcutaneous electrical nerve stimulation and acupuncture. In:  McMahon S,  Koltzenburg M editor. Textbook of Pain. 5th Edition. Philadelphia PA: Elsevier Churchill Livingstone; 2006;p. 583–590
  8. Bjordal JM, Johnson MI, Ljunggreen AE. Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain. Eur J Pain. 2003;7:181–188
  9. Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007;8:51
  10. Cathcart S, Pritchard D. Reliability of pain threshold measurement in young adults. J Headache Pain. 2006;7:21–26
  11. Chakour MC, Gibson SJ, Neufeld M, Khalil Z, Helme RD. Development of an active placebo for studies of TENS treatment. In:  Devor M,  Rowbotham MC,  Wiesenfeld-Hallin Z editor. Progress in pain research and management. Proceedings of the IXth World Congress on Pain. Seattle, WA: IASP Press; 2000;p. 987–992
  12. Charlton J. Task Force on Professional Education. In:  Charlton J editors. Stimulation-produced analgesia. Seattle, WA: IASP Press; 2005;p. 93–96
  13. Chartered Society of Physiotherapy. Guidance for the Clinical Use of Electrophysical Agents. 1st Edition. London UK: Chartered Society of Physiotherapy; 2006;
  14. Chen CC, Tabasam G, Johnson MI. Does the pulse frequency of Transcutaneous Electrical Nerve Stimulation (TENS) influence hypoalgesia? A systematic review of studies using experimental pain and healthy human participants. Physiotherapy. 2008;94:11–20
  15. Chesterton LS, Barlas P, Foster NE, Lundeberg T, Wright CC, Baxter GD. Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects. Pain. 2002;99:253–262
  16. Chesterton LS, Foster NE, Wright CC, Baxter GD, Barlas P. Effects of TENS frequency, intensity and stimulation site parameter manipulation on pressure pain thresholds in healthy human subjects. Pain. 2003;106:73–80
  17. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain. 2007;23:760–766
  18. Christidis N, Kopp S, Ernberg M. The effect on mechanical pain threshold over human muscles by oral administration of granisetron and diclofenac-sodium. Pain. 2005;113:265–270
  19. Christidis N, Nilsson A, Kopp S, Ernberg M. Intramuscular injection of granisetron into the masseter muscle increases the pressure pain threshold in healthy participants and patients with localized myalgia. Clin J Pain. 2007;23:467–472
  20. Claydon LS, Chesterton LS, Barlas P, Sim J. Effects of simultaneous dual-site TENS stimulation on experimental pain. Eur J Pain. 2008;12:696–704
  21. Clerc S, Vuilleumier H, Frascarolo P, Spahn DR, Gardaz JP. Is the effect of inguinal field block with 0.5% bupivacaine on postoperative pain after hernia repair enhanced by addition of ketorolac or S(+) ketamine?. Clin J Pain. 2005;21:101–105
  22. Cowan S, McKenna J, McCrum-Gardner E, Johnson MI, Sluka KA, Walsh DM. An Investigation of the Hypoalgesic Effects of TENS Delivered By a Glove Electrode. J Pain. 2009;Apr 22. [Epub ahead of print]
  23. Craig JA, Cunningham M, Walsh DM, Baxter GD, Allen JM. Lack of effect of transcutaneous electrical nerve stimulation upon experimentally induced delayed onset muscle soreness in humans. Pain. 1996;67:285–289
  24. de Tommaso M, Fiore P, Camporeale A, Guido M, Libro G, Losito L, et al. High and low frequency transcutaneous electrical nerve stimulation inhibits nociceptive responses induced by CO2 laser stimulation in humans. Neurosci Lett. 2003;342:17–20
  25. DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Curr Rheumatol Rep. 2008;10:492–499
  26. Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115–126
  27. Fischer AA. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain. 1987;28:411–414
  28. Gopalkrishnan P, Sluka KA. Effect of varying frequency, intensity, and pulse duration of transcutaneous electrical nerve stimulation on primary hyperalgesia in inflamed rats. Arch Phys Med Rehabil. 2000;81:984–990
  29. Handwerker HO, Kobal G. Psychophysiology of experimentally induced pain. Physiol Rev. 1993;73:639–671
  30. Howson DC. Peripheral neural excitability. Implications for transcutaneous electrical nerve stimulation. Phys Ther. 1978;58:1467–1473
  31. Johnson MI, Comments on Craig JA, Cunningham MB, Walsh DM, Baxter GD, Allen JM. Pain. 1996;67:285–289[letter]. Pain 71:208-209, 1997
  32. Johnson MI. Transcutaneous electrical nerve stimulation. In:  Watson T editors. Electrotherapy: Evidence Based Practice. 11th Edition. Edinburgh UK: Churchill Livingstone; 2008;p. 253–296
  33. Johnson MI, Ashton CH, Bousfield DR, Thompson JW. Analgesic effects of different frequencies of transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects. Pain. 1989;39:231–236
  34. Johnson MI, Ashton CH, Thompson JW. The consistency of pulse frequencies and pulse patterns of transcutaneous electrical nerve stimulation (TENS) used by chronic pain patients. Pain. 1991;44:231–234
  35. Johnson MI, Ashton CH, Thompson JW. An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS). Implications for clinical use of TENS. Pain. 1991;44:221–229
  36. Kalra A, Urban MO, Sluka KA. Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS). J Pharmacol Exp Ther. 2001;298:257–263
  37. Kern SE, Xie G, White JL, Egan TD. A response surface analysis of propofol-remifentanil pharmacodynamic interaction in volunteers. Anesthesiology. 2004;100:1373–1381
  38. King EW, Sluka KA. The effect of varying frequency and intensity of transcutaneous electrical nerve stimulation on secondary mechanical hyperalgesia in an animal model of inflammation. J Pain. 2001;2:128–133
  39. Kosek E, Ordeberg G. Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatment. Eur J Pain. 2000;4:229–238
  40. Lemming D, Sorensen J, Graven-Nielsen T, Lauber R, Arendt-Nielsen L, Gerdle B. Managing chronic whiplash associated pain with a combination of low-dose opioid (remifentanil) and NMDA-antagonist (ketamine). Eur J Pain. 2007;11:719–732
  41. Maeda Y, Lisi TL, Vance CG, Sluka KA. Release of GABA and activation of GABA(A) in the spinal cord mediates the effects of TENS in rats. Brain Res. 2007;1136:43–50
  42. Nikolajsen L, Ilkjaer S, Jensen TS. Effect of preoperative extradural bupivacaine and morphine on stump sensation in lower limb amputees. Br J Anaesth. 1998;81:348–354
  43. Palmer ST, Martin DJ, Steedman WM, Ravey J. Alteration of interferential current and transcutaneous electrical nerve stimulation frequency: Effects on nerve excitation. Arch Phys Med Rehabil. 1999;80:1065–1071
  44. Potter J, McCarthy C, Oldham J. Algometer reliability in measuring pressure threshold over normal spinal muscles to allow quantification of anti-nociceptive treatment effects. International Journal of Osteopathic Medicine. 2006;9:113–119
  45. Radhakrishnan R, King EW, Dickman JK, Herold CA, Johnston NF, Spurgin ML, et al. Spinal 5-HT(2) and 5-HT(3) receptors mediate low, but not high, frequency TENS-induced antihyperalgesia in rats. Pain. 2003;105:205–213
  46. Resende MA, Sabino GG, Candido CR, Pereira LS, Francischi JN. Local transcutaneous electrical stimulation (TENS) effects in experimental inflammatory edema and pain. Eur J Pharmacol. 2004;504:217–222
  47. Rolke R, Andrews Campbell K, Magerl W, Treede RD. Deep pain thresholds in the distal limbs of healthy human subjects. Eur J Pain. 2005;9:39–48
  48. Sjolund BH. Peripheral nerve stimulation suppression of C-fiber-evoked flexion reflex in rats. Part 1: Parameters of continuous stimulation. J Neurosurg. 1985;63:612–616
  49. Sluka KA, Bailey K, Bogush J, Olson R, Ricketts A. Treatment with either high or low frequency TENS reduces the secondary hyperalgesia observed after injection of kaolin and carrageenan into the knee joint. Pain. 1998;77:97–102
  50. Sluka KA, Deacon M, Stibal A, Strissel S, Terpstra A. Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther. 1999;289:840–846
  51. Sluka KA, Judge MA, McColley MM, Reveiz PM, Taylor BM. Low frequency TENS is less effective than high frequency TENS at reducing inflammation-induced hyperalgesia in morphine-tolerant rats. Eur J Pain. 2000;4:185–193
  52. Sluka KA, Lisi TL, Westlund KN. Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electric nerve stimulation in rats with joint inflammation. Arch Phys Med Rehabil. 2006;87:1137–1140
  53. Sluka KA, Vance CG, Lisi T. High-frequency, but not low-frequency, transcutaneous electrical nerve stimulation reduces aspartate and glutamate release in the spinal cord dorsal horn. J Neurochem. 2005;95:1794–1801
  54. Sluka KA, Walsh DM. Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. J Pain. 2003;4:109–121
  55. Treede RD, Rolke R, Andrews K, Magerl W. Pain elicited by blunt pressure: Neurobiological basis and clinical relevance. Pain. 2002;98:235–240
  56. Vance CG, Radhakrishnan R, Skyba DA, Sluka KA. Transcutaneous electrical nerve stimulation at both high and low frequencies reduces primary hyperalgesia in rats with joint inflammation in a time-dependent manner. Phys Ther. 2007;87:44–51
  57. Walsh DM. Review of experimental studies on TENS. In:  Walsh DM editors. TENS. Clinical Applications and Related Theory. 1st Edition. New York NY: Churchill Livingstone; 1997;p. 63–81
  58. Walsh DM. TENS. Clinical Applications and Related Theory. 1st Edition. New York NY: Churchill Livingstone; 1997;
  59. Walsh DM, Foster NE, Baxter GD, Allen JM. Transcutaneous electrical nerve stimulation. Relevance of stimulation parameters to neurophysiological and hypoalgesic effects. Am J Phys Med Rehabil. 1995;74:199–206
  60. Walsh DM, Liggett C, Baxter D, Allen JM. A double-blind investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon experimentally induced ischaemic pain. Pain. 1995;61:39–45
  61. Walsh DM, Lowe AS, McCormack K, Willer JC, Baxter GD, Allen JM. Transcutaneous electrical nerve stimulation: Effect on peripheral nerve conduction, mechanical pain threshold, and tactile threshold in humans. Arch Phys Med Rehabil. 1998;79:1051–1058
  62. Woolf CJ. Transcutaneous electrical nerve stimulation and the reaction to experimental pain in human subjects. Pain. 1979;7:115–127

 This project was funded by the Faculty of Health at Leeds Metropolitan University.

PII: S1526-5900(09)00572-0

doi: 10.1016/j.jpain.2009.05.008

The Journal of Pain
Volume 11, Issue 1 , Pages 53-61 , January 2010

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